The 3rd Era of Health Care - Don Berwick

Having just returned from the Choosing Wisely Canada national meeting in Toronto, I was reflecting on what I learned. There was much inspiration and practical suggestions around implementing and sustaining quality improvement, and some of these learnings will change my practice. 

I was also re-invigorated by the energy of the Students and Trainees Advocating for Resource Stewardship (STARS), and reassured by the Canadian Medical Protective Association's endorsement of the Choosing Wisely campaign.

Dr Dee Mangin delivered a compelling, philosophical keynote to close the conference; she explored the issues driving medicalization and polypharmacy, and offered some hope for taking action against these. There were many reality checks for the audience, and recent research on physician behaviours, publication biases, a society obsessed with risk surprised many. Some of this was very familiar to me from discussions and presentations within the Preventing Overdiagnosis community, but Dr Mangin has a way of explaining things in such a way that their profound nature hits you like a tonne of bricks. (This is a good thing!)

It was clear at the conference that things have to change. But what is that vision, exactly?

One idea that was new to me was that of the "3rd Era of Heath Care," a concept developed by Dr Don Berwick, of the Institute for Healthcare Improvement (IHI). Dr Mangin touched on it and I think it's an idea worth sharing:

VIDEO: A troubling pharmaceutical cocktail | Dee Mangin #WalrusTalks

Polypharmacy-smashing superstar Dee Mangin delivered a compelling talk for The Walrus about the problem of too much medicine.

In just over 8 minutes, she beautifully articulates the issue and a vision of how we can address it.

Source: https://www.youtube.com/watch?v=QQkV7yHuQ-...

MedStopper de-prescribing online app now live!

It is with great pleasure that I introduce: 

MedStopper 
 

Polypharmacy, the state of being on multiple (too many) medications, is an increasingly recognized problem. Though variably defined, everyone agrees that polypharmacy leads to dangerous consequences for patients, particularly in the elderly.

It is so much easier to start than to stop a medication. Now, there is help!

An incredible team, mostly from British Columbia, many of whom I'm had the pleasure of working with, have developed this superb resource. MedStopper is an online tool to help stop medications for patients.

Aimed at clinicians, this deprescribing aid allows you to created a medication list, suggests which medications need to be stopped first, and advises the safest way to go about stopping them. 

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Smiley/frowny faces show you the extent to which the medicine: may improve symptoms, may reduce risk for future illness, and may cause harm. If the patient is considered frail, the recommendations are adjusted accordingly.

The tool is a synthesis of many things, so you can view the Beers/STOPP criteria, the NNT or a risk/benefit calculator if available, and print out the plan if you desire.

Not sure if you (or your patients) are on too many medications? Use the Rxisk questionnaire.

Try out MedStopper today and be sure to use the feedback section to let the team know if there are any glitches or errors.

Congratulations to the group on creating this hands-on, easy to use, and practice changing tool. 

Source: http://medstopper.com/